Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 20 de 147
Filter
1.
Clin Transl Oncol ; 22(8): 1345-1354, 2020 Aug.
Article in English | MEDLINE | ID: mdl-31873914

ABSTRACT

INTRODUCTION: The aim is to assess the outcome of patients treated for vaginal carcinoma with radiation therapy in terms of long-term tolerance and survival. MATERIALS AND METHODS: This single-center retrospective study included patients with squamous cell carcinoma of the vagina treated with pelvic external beam radiation therapy (EBRT) with or without vaginal brachytherapy (VB) between 1990 and 2013. RESULTS: Thirty-seven patients were included with stage I (24%), II (60%), III (8%), or IV (8%) vaginal tumors. Median age was 66 years (range 27-86 years). Median tumor size was 4 cm (range 0.7-12 cm). Seven patients underwent first intention surgery. The 37 patients received pelvic EBRT (45 Gy) with inguinal irradiation in 57% of cases. Fifteen (41%) received concurrent chemotherapy. Low-dose supplemental VB was performed in 31 patients (84%) (median dose: 20 Gy). Median follow-up was 59 months (range 7-322 months). Four patients (11%) had late grade 3-4 complications. Relapse occurred in 11 patients (30%), five of them locally. The 5-year relapse-free and cancer-specific survival rates were 68% and 76%, respectively. Surgery and concurrent chemotherapy did not seem to have an impact on the course of the disease. CONCLUSION: In our experience, pelvic EBRT leads to prolonged survival with acceptable long-term toxicity in patients with squamous cell carcinoma of the vagina.


Subject(s)
Carcinoma, Squamous Cell/radiotherapy , Vaginal Neoplasms/radiotherapy , Adult , Aged , Aged, 80 and over , Antineoplastic Agents/therapeutic use , Brachytherapy/methods , Brachytherapy/statistics & numerical data , Cancer Care Facilities , Carcinoma, Squamous Cell/mortality , Carcinoma, Squamous Cell/pathology , Female , Humans , Hysterectomy/statistics & numerical data , Middle Aged , Neoplasm Recurrence, Local , Radiation Injuries/etiology , Radiotherapy Dosage , Retrospective Studies , Survival Rate , Treatment Outcome , Tumor Burden , Vaginal Neoplasms/mortality , Vaginal Neoplasms/pathology
2.
Cancer Radiother ; 20(8): 824-829, 2016 Dec.
Article in French | MEDLINE | ID: mdl-27789176

ABSTRACT

After publishing a retrospective series of 23 patients treated for a rectal squamous cell carcinoma with exclusive curative and conservative intent chemoradiation, we aim to propose a review of the literature about this rare tumour. We identified 11 retrospective studies, on 106 patients, treated between 2007 and 2016. Treatment of rectal squamous cell carcinoma should be similar to anal carcinoma, based on exclusive chemoradiation, displaying a 5-year overall survival rate over 80%, while it was 32% in surgical series. Baseline explorations should be similar as for anal carcinoma, with an interest in PET-CT at diagnosis and monitoring, after a delay over 6 weeks after chemoradiation. Intensity-modulated radiotherapy is legitimate, to a prophylactic dose between 36 and 45Gy, and over 54Gy to the tumour. Concomitant chemotherapy should combine an antimetabolite (5-fluorouracil or capecitabine) and mitomycin C, or cisplatin. This treatment seems well tolerated, associated with grade 2 or above toxicity below 30%. Follow-up should be established on anal squamous cell carcinoma schedule, with endoscopic ultrasonography and PET-CT. Rectal squamous cell carcinoma is a rare tumour; it management should be based on anal curative and conservative intent chemoradiation.


Subject(s)
Carcinoma, Squamous Cell/therapy , Rectal Neoplasms/therapy , Adult , Aged , Aged, 80 and over , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Capecitabine/administration & dosage , Carcinoma, Squamous Cell/diagnostic imaging , Carcinoma, Squamous Cell/mortality , Chemoradiotherapy , Cisplatin/administration & dosage , Clinical Trials as Topic , Colostomy , Combined Modality Therapy , Female , Fluorouracil/administration & dosage , France , Hospitals, University/statistics & numerical data , Humans , Male , Middle Aged , Mitomycin/administration & dosage , Positron Emission Tomography Computed Tomography , Radiodermatitis/etiology , Radiotherapy, Intensity-Modulated/adverse effects , Rectal Neoplasms/diagnostic imaging , Rectal Neoplasms/mortality , Retrospective Studies , Skin Ulcer/etiology , Survival Rate , Treatment Outcome
3.
Cancer Radiother ; 19(3): 175-9, 2015 May.
Article in French | MEDLINE | ID: mdl-25921619

ABSTRACT

PURPOSE: Women with ductal carcinoma in situ are treated with breast-conserving surgery and radiation therapy. The impact of an additive boost radiation is under evaluation. PATIENTS AND METHODS: All women treated for ductal carcinoma in situ with breast-conserving surgery and whole breast radiation therapy at a total dose of 45Gy with a boost radiation from 1990 to 2008 have been included in this retrospective monocentric retrospective study. RESULTS: We included 171 patients. Boost radiation to the surgical bed was delivered by brachytherapy in 66 patients (39%), by direct en-face electron beam in 86 patients (50%), and by tangential fields using photon beams in 19 patients (11%). Median follow-up was 95.1months. Eight local relapses (4.6%) have occurred. The 10-year local recurrence-free survival rate was 97%. The 10-year overall survival rate was 98%. On multivariable analysis, brachytherapy (P=0.05; HR=5.15; IC=1-26.3) was associated with a reduction risk of local recurrence-free survival. CONCLUSION: In our experience, women treated for a ductal carcinoma in situ with breast-conserving surgery and whole breast radiation therapy with a boost radiation have a high 10-year local recurrence-free survival rate.


Subject(s)
Brachytherapy/methods , Breast Neoplasms/radiotherapy , Carcinoma, Intraductal, Noninfiltrating/radiotherapy , Radiotherapy, High-Energy/methods , Adult , Aged , Breast Neoplasms/epidemiology , Carcinoma, Intraductal, Noninfiltrating/surgery , Combined Modality Therapy , Disease-Free Survival , Dose Fractionation, Radiation , Female , Follow-Up Studies , Humans , Mastectomy, Segmental , Middle Aged , Neoplasm Recurrence, Local/epidemiology , Neoplasm Recurrence, Local/prevention & control , Photons/therapeutic use , Proportional Hazards Models , Retrospective Studies , Treatment Outcome
4.
Eur Ann Otorhinolaryngol Head Neck Dis ; 132(3): 147-51, 2015 Jun.
Article in English | MEDLINE | ID: mdl-25553970

ABSTRACT

Radiation therapy (with associated chemotherapy) is the standard treatment for nasopharyngeal carcinoma. Conformal intensity-modulated radiation therapy is a new and particularly interesting technique for these tumors, due to their complex volumes close to many critical organs. Better dosimetric results and improved protection of adjacent healthy tissue have been shown compared with conventional 2D or 3D radiation therapy, with significantly reduced side-effects, notably xerostomia. Excellent local control rates have been reported.


Subject(s)
Nasopharyngeal Neoplasms/radiotherapy , Radiotherapy, Intensity-Modulated/methods , Carcinoma , Humans , Nasopharyngeal Carcinoma , Nasopharyngeal Neoplasms/pathology , Neoplasm Staging , Prognosis , Treatment Outcome , Xerostomia/prevention & control
5.
J Clin Pharm Ther ; 40(1): 116-8, 2015 Feb.
Article in English | MEDLINE | ID: mdl-25302593

ABSTRACT

WHAT IS KNOWN AND OBJECTIVE: Salivary glands tumours are rare neoplasms for which there are few clinical trials. The most common malignant parotid tumour is the mucoepidermoid carcinoma. High-grade mucoepidermoid carcinomas are highly aggressive tumours. The initial therapy of localized disease is known, but when there is a recurrence, several options are possible and chemotherapy is generally reserved for palliative treatment. We comment on published guidelines and report a case of sustained remission with docetaxel. CASE SUMMARY: Our case concerns a 64-year-old woman with a high-grade mucoepidermoid carcinoma of the parotid gland with local recurrence treated with docetaxel 50 mg/m² every 15 days. After the sixth cycle, a complete remission was observed on CT-scan. The tolerability was excellent. After 2 years of docetaxel, the patient was still in complete remission. WHAT IS NEW AND CONCLUSION: Docetaxel is an active drug for the treatment of mucoepidermoid carcinoma of salivary glands. A prospective study should confirm these data.


Subject(s)
Antineoplastic Agents/therapeutic use , Carcinoma, Mucoepidermoid/drug therapy , Neoplasm Recurrence, Local/drug therapy , Salivary Gland Neoplasms/drug therapy , Taxoids/therapeutic use , Carcinoma, Mucoepidermoid/diagnostic imaging , Docetaxel , Female , Humans , Middle Aged , Remission Induction , Salivary Gland Neoplasms/diagnostic imaging , Sialography/methods , Tomography, X-Ray Computed/methods
6.
Gynecol Obstet Fertil ; 42(9): 585-90, 2014 Sep.
Article in French | MEDLINE | ID: mdl-24993654

ABSTRACT

OBJECTIVES: The National Institute of the Cancer (INCA) recently published a study over the deadlines of medical care of breast cancers. We compared our delay within the framework of our expert center with their results. PATIENTS AND METHODS: Our work is a retrospective unicentric non-interventional study. We included all the patients taken care for a breast cancer to the hospital Tenon in Paris. The criteria of inclusion were a primitive breast cancer, having accepted a care for a first cancer operated over a period of three months. We recovered 9 key deadlines to study the care of our patients. RESULTS: Sixty-six patients were included. The mean age was of 55.6 years. The deadline of access to the hospital Tenon was 8.7 ± 7.7 days for the meetings of gynecology and 4.3 ± 4 days for those of radiology. The deadline of access to the diagnosis was 31.8 ± 26 days. The deadlines of access to the meeting of multidisciplinary dialogue pre-therapeutic was 13 ± 11 days. The access to the first management time was 18.5 days for the neoadjuvant chemotherapy and 13.5 days for surgery. The deadline of access to the postoperative therapeutic proposal was on average 20 ± 8 days. The deadline of access to the postoperative radiotherapy was of 197 days in case of postoperative chemotherapy vs 47.5 days without chemotherapy. The global deadline mammography-radiotherapy was of 188 days. DISCUSSION AND CONCLUSION: The deadline of access to the diagnosis, to the postoperative therapeutic proposal and the global deadline mammography-radiotherapy with adjuvant chemotherapy or neoadjuvant were longer in our center compared with the results of the INCA. The deadlines of access to the surgery and access to the radiotherapy without postoperative chemotherapy were shorter on the other hand. The contribution of the diagnosis in one day for breast cancer is probably going to allow us to improve the deadlines of care in our structure.


Subject(s)
Breast Neoplasms/therapy , Breast Neoplasms/diagnosis , Breast Neoplasms/surgery , Chemotherapy, Adjuvant , Delayed Diagnosis , Female , Humans , Middle Aged , Neoadjuvant Therapy , Paris , Radiotherapy, Adjuvant , Retrospective Studies , Time Factors
7.
Cancer Radiother ; 18(2): 83-8, 2014 Mar.
Article in French | MEDLINE | ID: mdl-24462252

ABSTRACT

PURPOSE: Evaluation of the results of salvage radiation therapy with curative intent in the treatment of recurrent cervical carcinoma. PATIENTS AND METHODS: Fourteen patients with a recurrence of a cervical cancer were treated in our department between 1982 and 2009. Five patients had a pelvic relapse, four a vaginal relapse and five a pelvic lymph node relapse. Four patients had first a surgical resection of the relapse, which was incomplete in two patients. All patients had pelvic radiotherapy with a median dose of 55Gy in conventional fractionation. Concurrent chemotherapy was administered to 12 patients. A vaginal brachytherapy with a median dose of 20Gy was performed in addition in 3 patients. The median follow-up was 39months. RESULTS: Safety of radiation therapy was correct with 29% of grade 3 acute or intestinal toxicity. Tumor control was observed in 10 patients (71%). Four patients presented a locoregional tumor progression. At the time of analysis, three patients had died from their cancer. From the date of relapse, the rate of overall survival at 2 and 5year was respectively 84% and 74%. Three patients (21%) had severe late effects. CONCLUSION: In our experience, chemoradiotherapy can achieve a high rate of remission in patients with isolated pelvic recurrence of cervical cancer. This treatment is feasible only if the patient had not received radiation therapy before or if the relapse is out of the previously irradiated volume.


Subject(s)
Chemoradiotherapy , Pelvic Neoplasms/therapy , Salvage Therapy , Uterine Cervical Neoplasms/pathology , Vaginal Neoplasms/therapy , Adenocarcinoma/mortality , Adenocarcinoma/pathology , Adenocarcinoma/secondary , Adenocarcinoma/therapy , Adult , Aged , Brachytherapy , Carcinoma, Squamous Cell/mortality , Carcinoma, Squamous Cell/pathology , Carcinoma, Squamous Cell/secondary , Carcinoma, Squamous Cell/therapy , Female , Humans , Hysterectomy , Lymph Node Excision , Lymphatic Metastasis , Middle Aged , Neoplasm Recurrence, Local , Pelvic Neoplasms/mortality , Pelvic Neoplasms/secondary , Radiotherapy Dosage , Retrospective Studies , Uterine Cervical Neoplasms/mortality , Uterine Cervical Neoplasms/therapy , Vaginal Neoplasms/mortality , Vaginal Neoplasms/secondary
8.
Gynecol Obstet Fertil ; 41(3): 164-7, 2013 Mar.
Article in French | MEDLINE | ID: mdl-23481026

ABSTRACT

OBJECTIVE: Multidisciplinary meeting (MDM) should ensure a homogeneous management of the patients by following breast cancer guidelines. Are these guidelines really applied in MDM decisions? PATIENTS AND METHODS: We reviewed the last 200 cases of patients operated in our department for breast cancer. We searched for each case if MDM had been consulted, at which step of the management and if the decision was in accordance with our guidelines. RESULTS: Mean age of the 200 patients was 56 (range 27-87)years old and 145 of them (72,5%) had an invasive breast cancer. All cases were presented to the MDM, 148 (74%) preoperatively and 200 (100%) postoperatively. Only four decisions did not follow our guidelines. In three cases, the decision was explained within the MDM report and in one case, the decision was not explained but could be understood. DISCUSSION AND CONCLUSION: We found a significant relation between MDM decisions and our guidelines. However, complex cases require adapting the guidelines to the particularity and the wishes of the patients.


Subject(s)
Breast Neoplasms/therapy , Patient Care Team , Adult , Aged , Aged, 80 and over , Breast Neoplasms/pathology , Female , Hospitals, University , Humans , Mastectomy , Middle Aged , Practice Guidelines as Topic , Radiotherapy, Adjuvant , Sentinel Lymph Node Biopsy
9.
Cancer Radiother ; 17(1): 44-9, 2013 Feb.
Article in French | MEDLINE | ID: mdl-23219138

ABSTRACT

The authors report a case of Dropped Head Syndrome with an unusually rapid onset after an accident in a patient with a history of Hodgkin's lymphoma cured by chemotherapy and mantle field radiotherapy and compare this case to the rare published cases of chronic Dropped Head Syndrome occurring after this type of treatment. A 56-year-old man was treated at the age 36 years for supra-diaphragmatic Hodgkin's lymphoma by chemotherapy and mantle field radiotherapy according to a standard technique and standard doses (40Gy, 20 fractions, 27 days). Seventeen years after the end of treatment, he experienced a violent whiplash injury, rapidly followed by a Dropped Head Syndrome, similar to the cases of chronic Dropped Head Syndrome already described in the context of Hodgkin's lymphoma (permanent flexion of the head, only reduced in the supine position). Physical and neurophysiological examination, electromyogram, and magnetic resonance imaging confirmed the diagnosis of Dropped Head Syndrome. Very few treatment options are available for the major disability related to Dropped Head Syndrome. This type of subacute onset of Dropped Head Syndrome has not been previously described. The good results of radiation therapy after chemotherapy allow a dose reduction to 30Gy in the involved regions. This, together with recent progress in treatment planning, should allow eradication of these complications.


Subject(s)
Cervical Plexus/radiation effects , Hodgkin Disease/radiotherapy , Muscle Weakness/etiology , Neck Muscles/innervation , Radiation Injuries/etiology , Radiotherapy, High-Energy/adverse effects , Whiplash Injuries/complications , Accidents, Traffic , Antineoplastic Combined Chemotherapy Protocols/administration & dosage , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Bleomycin/administration & dosage , Cervical Plexus/injuries , Cervical Plexus/physiopathology , Cervical Vertebrae , Combined Modality Therapy , Dacarbazine/administration & dosage , Dose Fractionation, Radiation , Doxorubicin/administration & dosage , Electromyography , Hodgkin Disease/complications , Hodgkin Disease/drug therapy , Humans , Magnetic Resonance Imaging , Male , Mechlorethamine/administration & dosage , Middle Aged , Muscle Weakness/physiopathology , Neck Muscles/physiopathology , Osteoarthritis/complications , Prednisone/administration & dosage , Procarbazine/administration & dosage , Radiation Injuries/physiopathology , Radiotherapy Dosage , Remission Induction , Vinblastine/administration & dosage , Vincristine/administration & dosage
10.
Cancer Radiother ; 16(5-6): 444-51, 2012 Sep.
Article in French | MEDLINE | ID: mdl-22951488

ABSTRACT

PURPOSE: The main objective of the economical study was to prospectively and randomly assess the additional costs of daily versus weekly patient positioning quality control in image-guided radiotherapy (IGRT), taking into account the modalities of the 3D-imaging: tomography (CBCT) or gold seeds implants. A secondary objective was to prospectively assess the additional costs of 3D versus 2D imaging with portal imaging for patient positioning controls. PATIENTS AND METHODS: Economics data are issued from a multicenter randomized medico-economics trial comparing the two frequencies of patient positioning control during prostate IGRT. A prospective cohort with patient positioning control with PI (control group) was constituted for the cost comparison between 3D (IGRT) versus 2D imaging. The economical evaluation was focused to the radiotherapy direct costs, adopting the hospital's point of view and using a microcosting method applied to the parameters that may lead to cost differences between evaluated strategies. RESULTS: The economical analysis included a total of 241 patients enrolled between 2007 and 2011 in seven centres, 183 in the randomized study (128 with CBCT and 55 with fiducial markers) and 58 in the control group. Compared to weekly controls, the average additional cost per patient of daily controls was €847 (CBCT) and €179 (markers). Compared to PI, the average additional cost per patient was €1392 (CBCT) and €997 (fiducial markers) for daily controls; €545 (CBCT) and €818 (markers) in case of weekly controls. CONCLUSION: A daily frequency for image control in IGRT and 3D images patient positioning control (IGRT) for prostate cancer lead to significant additional cost compared to weekly control and 2D imaging (PI). Long-term clinical assessment will permit to assess the medico-economical ratio of these innovative radiotherapy modalities.


Subject(s)
Prostatic Neoplasms/economics , Prostatic Neoplasms/radiotherapy , Radiotherapy, Image-Guided/economics , Adenocarcinoma/economics , Adenocarcinoma/radiotherapy , Aged , Cone-Beam Computed Tomography , Cost-Benefit Analysis , Gold , Humans , Imaging, Three-Dimensional/economics , Male , Prospective Studies , Prostheses and Implants , Radiotherapy Setup Errors/prevention & control
11.
Br J Cancer ; 106(1): 39-44, 2012 Jan 03.
Article in English | MEDLINE | ID: mdl-22146520

ABSTRACT

OBJECTIVE: Detection of lymph node involvement in women with IB2-IIB cervical cancer could have a positive effect on survival. We set out to evaluate the incidence of pelvic and/or para-aortic lymph node involvement using the sentinel node (SN) biopsy and its impact on survival. METHODS: From 2002 to 2010, 66 women with IB2-IIB cervical cancer underwent a pelvic and paraaortic lymphadenectomy with SN biopsy. Survival between groups according to lymph node status was evaluated. RESULTS: Mean tumour size was 43.5 mm. At least one SN was detected in 69% of the 45 SN procedures performed. Sixteen of these patients had metastatic SN and the false negative rate was 20%. Metastatic pelvic SNs or non-SNs were detected in 33 patients (50%), including pelvic-positive nodes in 26 (40%), pelvic- and paraaortic-positive lymph nodes in seven (11%), and paraaortic skip metastases in two (6%). Positive paraaortic node was the sole determinant for disease-free survival (DFS) and overall survival (OS; P<0.001). Differences in DFS and OS between groups according to the nodal status were observed (P<0.001). CONCLUSION: SN procedure gave a higher rate of metastasis detection. Further studies are required to evaluate whether pre-therapeutic node staging, including paraaortic and pelvic lymphanedectomy, should be performed.


Subject(s)
Lymph Node Excision , Lymphatic Metastasis , Sentinel Lymph Node Biopsy , Uterine Cervical Neoplasms/pathology , Adult , Aged , Antineoplastic Agents/therapeutic use , Aorta/pathology , Aorta/surgery , Combined Modality Therapy , Female , Humans , Middle Aged , Pelvis/pathology , Pelvis/surgery , Radiotherapy , Survival Analysis , Uterine Cervical Neoplasms/drug therapy , Uterine Cervical Neoplasms/radiotherapy , Uterine Cervical Neoplasms/surgery
12.
Cancer Radiother ; 15(5): 365-75, 2011 Aug.
Article in French | MEDLINE | ID: mdl-21664851

ABSTRACT

Pancreatic carcinoma is the fifth leading cause of cancer-related mortality. The 5-year overall survival is less than 5 %. This very poor prognosis can be explained both by late diagnosis and by treatment resistance, including resistance to radiation therapy. A better understanding of the pancreatic tumorigenesis and knowledge of the most frequent mutations in pancreatic adenocarcinoma (KRAS, p16, TP53, Smad4) open new perspectives for the development of more effective treatments. This review presents the major genetic and molecular alterations in pancreatic cancer that could be targeted to improve radiosensitization.


Subject(s)
Carcinoma, Pancreatic Ductal/genetics , Cell Transformation, Neoplastic/genetics , Pancreatic Neoplasms/genetics , Antimetabolites, Antineoplastic/pharmacokinetics , Antimetabolites, Antineoplastic/therapeutic use , Carcinoma in Situ/genetics , Carcinoma in Situ/pathology , Carcinoma, Pancreatic Ductal/diagnosis , Carcinoma, Pancreatic Ductal/drug therapy , Carcinoma, Pancreatic Ductal/epidemiology , Carcinoma, Pancreatic Ductal/pathology , Carcinoma, Pancreatic Ductal/radiotherapy , Cystadenoma, Mucinous/pathology , Delayed Diagnosis , Deoxycytidine/analogs & derivatives , Deoxycytidine/pharmacokinetics , Deoxycytidine/therapeutic use , Disease Progression , Genes, Tumor Suppressor , Humans , Intercellular Signaling Peptides and Proteins/physiology , Mutation , Neoplasm Proteins/antagonists & inhibitors , Neoplasm Proteins/physiology , Oncogenes , Pancreatic Neoplasms/diagnosis , Pancreatic Neoplasms/drug therapy , Pancreatic Neoplasms/epidemiology , Pancreatic Neoplasms/pathology , Pancreatic Neoplasms/radiotherapy , Precancerous Conditions/pathology , Radiation Tolerance , Signal Transduction/genetics , Gemcitabine
13.
Cancer Radiother ; 14 Suppl 1: S94-102, 2010 Nov.
Article in French | MEDLINE | ID: mdl-21129675

ABSTRACT

About 7200 new cases of pancreatic adenocarcinomas are diagnosed each year in France. At the time of diagnosis, an efficient carcinologic surgery will not be possible for nearly 80% of patients, in relation to loco-regional extension or metastatic dissemination. After surgical resection, the median survival of resected patients ranges from 12 to 20 months, with a high rate of relapses. Currently, the use of radiotherapy for patients with pancreatic cancer is controversial. In adjuvant setting, the standard treatment is six months of chemotherapy with FUFOL or gemcitabine. Chemoradiation (CRT) may improve the survival of patients with incompletely resected tumors (R1). This must be validated in a prospective trial. Neoadjuvant CRT is a promising treatment but always under evaluation. For the treatment of patients with locally advanced tumors, there is not a standart treatment. A strategy of initial chemotherapy followed by CRT for non progressive patients is under evaluation. Whereas in the first trials of CRT large fields were used, the current trend is to reduce the treated volumes to improve tolerance. The delineation of target volumes has been improved by the use of simulation CT. The aims of this work are to precise the radio-anatomical particularities, the pattern of spread of pancreatic cancer and the principles of 3D conformal radiotherapy illustrated with a clinical case.


Subject(s)
Adenocarcinoma/radiotherapy , Pancreatic Neoplasms/radiotherapy , Adenocarcinoma/drug therapy , Adenocarcinoma/epidemiology , Adenocarcinoma/pathology , Adenocarcinoma/surgery , Combined Modality Therapy , France , Humans , Neoplasm Metastasis , Pancreas/anatomy & histology , Pancreas/pathology , Pancreatic Neoplasms/drug therapy , Pancreatic Neoplasms/epidemiology , Pancreatic Neoplasms/pathology , Pancreatic Neoplasms/surgery , Radiotherapy, Conformal/methods , Recurrence , Survival Rate , Time Factors
14.
Cancer Radiother ; 14(2): 119-27, 2010 Apr.
Article in French | MEDLINE | ID: mdl-20004125

ABSTRACT

PURPOSE: A survey of the literature has been performed to find arguments in order to help the choice between radiosurgery and hypofractionated stereotactic radiotherapy in the treatment of brain metastases. PATIENTS AND METHODS: A comparison of two groups of brain metastases treated with hypofractionated stereotactic radiotherapy or radiosurgery, with or without WBRT was performed. Hypofractionated stereotactic radiotherapy: there were eight series including 448 patients published from 2000 to 2009; treated with 5-6 MV X-Rays, non invasive head immobilization, a margin 2 to 10mm; 24 to 40Gy in three to five fractions; a 5 to 8 days duration in six series and 15-16 days in two other series. WBRT (30%) ; radiosurgery: there were 12 series (1994 to 2005) including 2157 patients; an invasive head immobilization, no margin; doses from 10 to 25 Gy; six series over 12 had Gamma Knife radiosurgery and six had Linacs X-Rays. WBRT (30 Gy/10 F/12 days) associated to radiosurgery in several series. The following parameters were compared: median GTV, median survival, 1-year survival rate, local control rate, necrosis and WBRT rates. RESULTS: Hypofractionated stereotactic radiotherapy series: the parameters were respectively: 0,52-4,47 cm(3) (median 2,8 cm(3)); 5-16 months (median 8,7 months); 68,2-93% (median 82,5%); necrosis rate 3,1%; associated WBRT 30%. Radiosurgery series: the parameters were respectively: 1,3 to 5,5 cm(3) (median 2 cm(3)); 5,5 to 22 months (median 11 months); 71 to 95% (median 85%); 0,5 to 6% (median 2,4%); associated WBRT 58%. Results seem similar in the two groups: Hypofractionated stereotactic radiotherapy with non invasive immobilization could theoretically treat all brain metastases sizes except lesions<10 mm (500 mm(3)). In large volumes,>4200 mm(3) GTV, the toxicity of hypofractionated stereotactic radiotherapy was not reported, thus it was difficult to compare its results with the published reports of radiosurgery toxicity. WBRT was a confusing parameter. Obviously, this initial survey has important limitations, specifically its methodology. CONCLUSION: Radiosurgery and hypofractionated stereotactic radiotherapy could be used to treat brain metastases with GTV>500 mm(3) and < or = 4200 mm(3) (Ø 20mm); for GTV<500 mm(3) (Ø 10mm) an invasive procedure with radiosurgery is necessary. For GTV>4200 mm(3) (Ø 20mm), hypofractionated stereotactic radiotherapy could be proposed, provided further studies, using 4 to 6 Gy fractions, a duration less or equal to 10-12 days and a margin of 2mm will be performed.


Subject(s)
Brachytherapy/methods , Brain Neoplasms/secondary , Brain Neoplasms/surgery , Neoplasm Metastasis/radiotherapy , Brain Neoplasms/pathology , Humans , Necrosis , Radiotherapy Dosage , Survival Rate , Time Factors
15.
Cancer Radiother ; 13(8): 731-9, 2009 Dec.
Article in French | MEDLINE | ID: mdl-19854091

ABSTRACT

PURPOSE: The work presented herein rests on the study of the Varian EPID aS500-II and the Image Acquisition system IAS3. We assessed the dosimetric performance of this EPID for measurements and quality assurance of enhanced dynamic wedge profiles and wedge factors. MATERIALS AND METHODS: We evaluated the dosimeter properties using the integrated asynchronous mode of acquisition in treatments with enhanced dynamic wedges (EDW). We studied the performance, stability and the reproducibility in measurements of the transmission factors and profiles of the fields with dynamic wedges. EPID profiles were compared to the "Profiler Sun Nuclear" diode array and PTW ion chamber. Analytical functions were developed in order to correct EDW profiles. The dependence of EPID measurements on wedge direction, beam dimensions and source to EPID distance was assessed. RESULTS: The backscatter produced by the "exact arm" was evaluated; EPID profiles depended on the EDW direction and on the detector source distance. Wedge factors were determined using this detector and compared to the ion chamber response, differences were all within 1 %. Two empirical correction functions were developed to produce EPID wedge profiles that correspond to diode for all wedge angles and energies depending on the wedge direction. CONCLUSION: The EPID is highly suited to regular measurement of EDW due to the reproducibility of the EPID-measured wedge factors and profiles.


Subject(s)
Radiotherapy Planning, Computer-Assisted/methods , Humans , Quality Control , Radiotherapy Dosage , Radiotherapy Planning, Computer-Assisted/instrumentation
16.
Cancer Radiother ; 13(3): 145-52, 2009 Jun.
Article in French | MEDLINE | ID: mdl-19269876

ABSTRACT

PURPOSE: In case of external breast radiotherapy, the usual treatment consists of two tangential beams homogeneously attenuated by a dynamic or physics wedge in order to obtain the most homogeneous dose distribution as possible. Depending of the shape and size of the breast volume, we may observe with this technique dose heterogeneity over 20% from the recommendation of the International Committee on Radiation Units and Measurements (95-107%). We propose to study breast treatment planning by compensating tissues thickness in order to decrease dose heterogeneity observed on the dose distribution for conventional treatment. MATERIALS AND METHODS: We have segmented the initial tangential beams used for this kind of treatment into several smaller beams. Their shape was adapted to the distribution of the greys level on the DRR image. Therefore, we have compensated the thickness gradient and we have given the right dose to the right thickness group. RESULTS: Dose distribution performed with this method shows an improvement of the dose homogeneity in the three space dimensions and a decrease of the maximal dose between 5 and 10% over the ICRU recommendation. CONCLUSION: This technique allows us to perform breast irradiation on a single photon energy linac even if the treated volume presents important thickness gradient. However, in case of large breast, this method is not able to reduce the overdosage at the entry of the volume due to inappropriate photon energy relative to the breast thickness.


Subject(s)
Breast Neoplasms/radiotherapy , Radiotherapy, Intensity-Modulated , Female , Humans , Radiotherapy Dosage , Radiotherapy Planning, Computer-Assisted
17.
Bull Cancer ; 95(7): 717-34, 2008.
Article in French | MEDLINE | ID: mdl-18763385

ABSTRACT

UNLABELLED: At the request of the National Thesaurus of Gastrointestinal Cancer (TNCD), the SOR program undertaken by the French federation of cancer centers and now led by the French National Cancer Institute, completed a systematic review to evaluate the value of perioperative chemotherapy in the management of resectable rectal adenocarcinoma in collaboration with clinician experts. METHODS: Results of a systematic literature search using Medline and Embase (from January 1996 to October 2007) were completed by a survey of Evidence- Based Medicine websites. All phase III randomized trials and systematic reviews comparing surgery (alone or associated with adjuvant therapy) to the same treatment plus chemotherapy, or comparing different perioperative chemotherapy modalities in patients with resectable rectal adenocarcinoma, were included in the study. The quality and clinical relevance of the trials were evaluated using validated checklists, allowing to associate each result with its level of evidence. Data synthesis was performed taking into account both efficacy and toxicity outcomes for each intervention. Finally, research recommendations were formulated. RESULTS: Of 29 studies meeting the selection criteria, 19 were included after critical methodological and clinical appraisal. As compared with preoperative radiotherapy, preoperative chemoradiotherapy with 5-fluorouracil and folinic acid does not improve overall or relapse-free survivals but decreases local recurrence rates. Postoperative chemotherapy with 5-fluorouracil and folinic acid does not improve overall or relapse-free survivals, whether the patients received preoperative radiotherapy or preoperative chemoradiotherapy, whereas it seems to decrease local recurrence rates after preoperative radiotherapy but not after preoperative chemoradiotherapy. As compared with postoperative chemoradiotherapy, preoperative chemoradiotherapy with continuous infusion of 5-fluorouracil does not improve overall or relapse-free survivals, but decreases local recurrence rates as well as acute and long-term toxicities. In the absence of preoperative radiotherapy, fluoropyrimidine-based postoperative chemotherapy improves both overall and relapse-free survivals and decreases local recurrence rates. CONCLUSIONS: Preoperative chemoradiotherapy reduces the risk of local recurrence as compared with preoperative radiotherapy or postoperative chemoradiotherapy.


Subject(s)
Adenocarcinoma/drug therapy , Antineoplastic Agents/therapeutic use , Rectal Neoplasms/drug therapy , Adenocarcinoma/radiotherapy , Adenocarcinoma/surgery , Clinical Trials, Phase III as Topic , Humans , Randomized Controlled Trials as Topic , Rectal Neoplasms/radiotherapy , Rectal Neoplasms/surgery
18.
Cancer Radiother ; 12(6-7): 633-9, 2008 Nov.
Article in French | MEDLINE | ID: mdl-18693057

ABSTRACT

FDG-(18F) PET can now be usually included in the treatment strategy of esophageal cancers for the pretreatment staging in operable tumours or for the diagnosis of recurrence. PET is also a good tool in conformal radiation therapy for improving the target coverage to treat the metabolic target volume or the biological target volume. Furthermore, PET seems to be interesting for evaluation of tumour response and could modify the treatment strategy after neoadjuvant chemotherapy or concurrent chemotherapy and radiation therapy. New radiotracers could allow advances in biological and molecular tumour delineation and contribute to change in treatment strategy based on functional and biological imaging.


Subject(s)
Esophageal Neoplasms/diagnostic imaging , Esophageal Neoplasms/pathology , Positron-Emission Tomography/methods , Radiotherapy, Conformal/methods , Antineoplastic Agents/therapeutic use , Combined Modality Therapy , Esophageal Neoplasms/drug therapy , Esophageal Neoplasms/radiotherapy , Esophageal Neoplasms/surgery , Fluorodeoxyglucose F18 , Follow-Up Studies , Humans , Neoplasm Staging/methods , Prognosis
20.
Rev Pneumol Clin ; 63(3): 211-22, 2007 Jun.
Article in French | MEDLINE | ID: mdl-17675945

ABSTRACT

Much progress has been made in recent years in administration modalities for external radiotherapy of non-small-cell lung carcinoma. Three-dimensional conformal radiotherapy with or without intensity modulation, with respiratory gated radio-therapy (4D radiotherapy), and image-guided radiotherapy (IGRT) can be considered as a third revolution in radiation therapy after total dose fractionation and the development of megavoltage radiation therapy equipment. We describe progress in the three-dimensional radiotherapy technique and the integration of this technique in the department of Radiation Oncology at Tenon hospital (AP-HP).


Subject(s)
Carcinoma, Non-Small-Cell Lung/radiotherapy , Lung Neoplasms/radiotherapy , Dose Fractionation, Radiation , Humans , Image Processing, Computer-Assisted , Imaging, Three-Dimensional , Radiosurgery , Radiotherapy Planning, Computer-Assisted , Radiotherapy, Computer-Assisted , Radiotherapy, Conformal , Radiotherapy, High-Energy , Radiotherapy, Intensity-Modulated , Technology, Radiologic , Tomography, Spiral Computed , User-Computer Interface
SELECTION OF CITATIONS
SEARCH DETAIL
...